SAM PARK Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****38

License Status

ACTIVE

Business

First Name

SAM

Last Name

PARK

Business Name

SAM PARK

Original Issue Date

06/18/2002

Effective Date

05/01/2024

Expiration Date

09/30/2027

City

CHICAGO

State

Zip

60616

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/01/2024